PURPOSE: This study was designed to compare outcomes of transanal and vaginal techniques for rectocele repair. METHODS: Thirty females with symptomatic rectocele were enrolled in a prospective, randomized study. Fifteen underwent transanal rectoceleplasty, the other 15 underwent vaginal posterior colporrhaphy. Patients were assessed by clinical interview and examination, defecography, colon transit study, and anorectal manometry before randomization and 12 months postoperatively. Patients with compromised anal sphincter function or other symptomatic prolapse were excluded. RESULTS: The study groups were comparable in terms of demo graphic factors and rectocele-related symptoms and signs. Eleven (73 percent) patients in the vaginal group and 10 (66 percent) in the transanal group digitally assisted rectal emptying preoperatively. The mean depth of the rectocele was 6 .0 ±1.6 cm vs. 5.6 ±1.8 cm (P = 0.53) in the respective groups. At follow-up, 14 (93 percent) patients in the vaginal group and 11 (73 percent) in the transa nal group reported improvement in symptoms (P = 0.08). Need to digitally assist rectal emptying decreased significantly in both groups, to one (7 percent) for t he vaginal group and four (27 percent) for the transanal group (P = 0.17 between groups). The respective recurrence rates of rectocele were one (7 percent) vs. six (40 percent) (P = 0.04), and enterocele rates were zero vs. four (P = 0.05). In the vaginal group defecography showed a significant decrease in rectocele depth whereas in the transanal group the difference did not reach statistical signif icance. None of the patients reported de novo dyspareunia, but 27 percent report ed improvement. CONCLUSION: Patientssymptoms were significantly alleviated by both operative techniques. The transanal technique was associated with more clin ically diagnosed recurrences of rectocele and/or enterocele. Adverse effects on sexual life were avoided by use of both techniques. METHODS: Thirty females with symptomatic rectocele were enrolled in a prospective, randomized study. Fifteen underwent transanal rectoceleplasty, the other 15 underwent vaginal posterior colporrhaphy. Patients were primed to vagal techniques for rectocele repair. METHODS by clinical interview and examination, defecography, colon transit study, and anorectal manometry before randomization and 12 months postoperatively. Patients with compromised anal sphincter function or other symptomatic prolapse were excluded. RESULTS: The study groups were comparable in terms of demo graphic factors and rectocele Eleven (73 percent) patients in the vaginal group and 10 (66 percent) in the transanal group digitally assisted rectal emptying preoperatively. The mean depth of the rectocele was 6.0 ± 1.6 cm vs. 5.6 ± 1.8 cm (P = 0.53) in the respective groups. At follow-up, 14 (93 percent) patients in the vaginal g Need of digitally assist rectal emptying decreased significantly in both groups, to one (7 percent) for t he vaginal group and four (27 percent ) for the transanal group (P = 0.17 between groups). The same recurrence rates of rectocele were one (7 percent) vs. six (40 percent) (P = 0.04), and enterocele rates were zero vs. four ) In the vaginal group defecography showed a significant decrease in rectocele depth in in the transanal group the difference did not reach statistical signif icance. None of the patients reported de novo dyspareunia, but 27 percent report ed improvement. CONCLUSION: Patients’symptoms were significantly reversediated on both operative techniques. The transanal technique was associated with more clinically diagnosed recurrences of rectocele and / or enterocele. Adverse effects on sexual life were avoided by use of both techniques.